By Chioma Obinna
Yesterday, February 4, was World Cancer Day, a day set aside by the United Nations and World Health Organisation to raise awareness on cancer and encourage prevention, detection, and treatment. The day is part of the big war against global cancer epidemic. Just as cancer affects everyone in different ways, people have the power to take action to reduce the impact on individuals, families and communities.
This is why the day, this year, took place under the theme: “We can. I can”.
Sunday Vanguard looks at the pains cancer patients go through in the quest for treatment and how to stop the disease before it stops anyone.
Cancer has been adjudged as the deadliest, the most expensive ailment to treat and the world’s No. 1 killer disease. Unfortunately, the management of cancer in Nigeria has remained a national scandal. According to the World Health Organisation (WHO) estimates, over 100,000 Nigerians are diagnosed with cancer ever year, while about 80,000 die from the disease. Nigeria’s cancer death ratio of 4 in 5 affected persons is one of the worst in the world and, while 240 Nigerians die of the disease daily, 10 die every hour.
Statistics show that one out of every three persons will be diagnosed with cancer in their lifetime and the worldwide burden of cancer is set to double by 2020 and nearly triple by 2030. And most worrisome is the fact that about 70 per cent of cancer deaths occur in developing countries like Nigeria.
Evidence abound that cervical cancer, which is virtually 100 per cent preventable, kills one Nigerian woman every hour. Breast cancer kills 40 Nigerians daily. Prostate cancer kills 26 Nigerian men daily. These three common cancers alone kill 90 Nigerians daily.
The sad statistics explain the earnest quest by the 8th National Assembly to urgently tackle the dire health challenge. But how far has the parliament gone?
The plight of patients
As you read this article, many Nigerians are dying of cancer either because they cannot afford the cost of the treatment or there is no functional treatment centre or they were misdiagnosed which led to late presentation.
In essence, Nigerians pay for cancer treatment with their lives. Although cancer is no longer a death sentence in developed countries, it is one of the most expensive disorders to treat and manage and, with the N18,000 minimum wage, the total life time cost of handling cancer in Nigeria is colossal, perhaps unquantifiable.
The situation, according to victims, is a helpless one. For the rich, only palliative care is available in most cases of late presentation while, for the poor, there is little or no hope of survival. Everything about cancer is expensive. Cost of treatment of cervical cancer, colon cancer, breast cancer, lung cancer, prostate cancer and any kind of cancer for that matter is mind-boggling. Even routine cancer therapy is no more affordable in Nigeria. It is an expensive and impoverishing disease.
To renowned oncologist, Lagos University Teaching Hospital, LUTH, Prof. Remi Ajekigbe, “the poor cannot survive cancer and even the rich do not always survive.”
The reason, according to him, is because treatment is either unavailable or, where available, it is extremely expensive. “The cost involved in treatment, coupled with the impact of disability and loss of life, is significant. From the drugs, radiotherapy, and chemotherapy, the cost is prohibitive.”
Currently, Nigeria has no comprehensive cancer centre, and lacks adequate treatment facilities hence Nigerians are compelled to spend over $200 million annually on treatment abroad.
Even for the rich who have the option of going abroad, they travel and still die. An average cancer patient, on regular screening, clinical assessment and chemotherapy, over the course of a year, may accumulate closed to N20 million or more in medical bills depending on the type of cancer, the type of treatment and where the treatment is being accessed. Certainly many patients cannot afford costs like these.
Today, an average Nigerian cancer patient is less likely to get regular screening tests, such as pap tests and colonoscopies, which catch the disease in its early, more curable stages. That person is less likely to be in good health generally in the first place and thus unable to fight cancer if it occurs. He is less likely to be on a health plan that will enable him to get to the doctor sooner when cancer symptoms first appear. Prognosis is worse as the cancer is more likely to have spread by the time they see a doctor and they are less likely to get high-quality cancer treatments and benefit from state-of-the-art technology.
Right now, most of the cancer treatment machines are broken-down and one or two working are not performing optimally. The alarming death rate from cancer in Nigeria is not unconnected with poor infrastructure. One of the challenges of cancer care and management in Nigeria is the lack of Mobile Cancer Centres, MCCs. Most Nigerians have no access to basic cancer screening. Likewise, Nigeria has no single Comprehensive Cancer Centre; therefore, most Nigerians have no access to optimal cancer treatment. Many Nigerian cancer patients today go as far as to Ghana to complete their radiotherapy treatment.
According to experts, cancer patients with no access to chemotherapy, radiotherapy or surgery constitute the bulk of those who inevitably die.
Another area that is plaguing Nigerian cancer patients is the issue of drugs. Most cancer drugs are available in Nigeria but none is manufactured in Nigeria, thereby making the costs prohibitive. The distribution is inefficient, and efficacy is uncertain. Drug prices are so high in the first place due to the cost of researching the drugs. The average cancer drug costs an estimated N10 million to research.
Worse still, cases of misdiagnosis abounds. If many victims were diagnosed accurately and early, most of the prognosis would have been better. Information by the National Cancer Control Programme, NCCP, showed that a Comprehensive Cancer Centre costs about $63 million, while a Mobile Cancer Centre costs about $600,000. Radiotherapy which is one of the essential equipment needed to manage cases of cancer is unavailable in most tertiary hospitals.
Patient accounts
A case in point is that of Mr. Williams O’Dwyer, a colorectal cancer survivor, who narrated his ordeal to Sunday Vanguard.
According to Williams, most of health centres make a lot of assumptions.
Williams claimed misdiagnosis could have ended his life, saying: “In my case, I started having the symptoms way back in 2012; it could have been detected considering the fact that I sought medical attention on time but I was wrongly diagnosed and treated with wrong drugs. But If I had been treated rightly from time, probably I would not have gone for surgery. You can imagine how many other people have gone through this situation and they ended up with stage four cancers.
“Fortunately for me, my cancer was detected at stage one but just at the nick of time because I went to a teaching hospital but there is overburden because the process before you get to see a consultant will probably take you over four weeks and, for someone suffering from cancer, that indeed is a lot of time. So, I was lucky but the question is how many people out there are as lucky as I am?
How many people are fortunate to get the proper diagnosis? How many people can afford to go for the tests? The tests that you need to do to detect if you have cancer or not are not cheap and even centres that provide such services are few and far between and, wherever they are available, they do cost a lot; so if I wasn’t fortunate to afford it, what happens to the less fortunate ones in our society?
Is it because we are in the society that doesn’t care for its people or we are in a society that doesn’t take health care insurance serious or capture a lot of our population in its health care net? It means you will die because, after all, most people end up dying because of the insensitivity of govt., the providers, and our society.”
To Williams, dedicated centres for cancer screening are inevitable. “We need dedicated centres for screening cancer. We need fast-track treatment for those suffering from or diagnosed with cancer, especially colon cancer. We need more awareness, more exposure of people to what symptoms to look out for to avoid full grown colorectal cancer”, he stated.
Stop cancer before it stops you – experts recommend tips
Meanwhile, the economic toll of cancer is enormous on cancer patients and families. This is why cancer is now the world’s most expensive and deadliest disorder.
The Chief Medical Personnel, Niola Cancer Care Foundation, Dr Adedapo Osinowo, said setting up a cancer screening centre is like acquiring 10 brand new exotic cars.
Although the message remains “early detection is key”, detecting and preventing cancer in the first place are two different things. According to oncologists, prevention involves finding out what causes cancer and minimising those risks but it is easier said than done in Nigeria.
According to WHO, one- third of all cancers can be prevented; another one- third can be effectively cured with early diagnosis; whilst palliative care can improve the quality of life of the last third.
Colorectal and cervical cancer, in particular, underscores the fact that cancer is preventable, and epitomises the cost-effectiveness of investing in preventive health care. Cervical screening is the best cancer screening test in the history of medicine and the most cost effective of all medical screening tests. The screening is painless and takes only about five minutes.
But unfortunately, in Nigeria, most women are not aware of the need for cervical cancer screening; many have never had cervical cancer screening in their lifetime. And cervical cancer kills one woman every hour in the country.
According to Osinowo, who is also a specialist laparoscopic and colorectal surgeon, anyone can be affected by the disease.
“To prevent cancers like colorectal cancer (colon cancer), people should eat everything in moderation”, he stated. “People should reduce the intake of high fat foods such as ponmo, smoked fish, red meat, abodi and ifun among others. These can cause cancer because of the way they are prepared. When these foods are prepared, they tend to bring about harmful substances that can cause cancer.
“The danger in colon cancer is that it could be silent. This is why people need to go for early screening because, with early screening, colon cancer can be prevented at polyps’ stage.”
Another expert, Associate Director for Cancer Prevention and Control at Moffitt Cancer Centre, Tampa, Thomas A. Sellers, says as many as 70 per cent of known causes of cancers are avoidable and related to lifestyle .
Diet, exercise, and avoidance of tobacco products are first line of defense, but recent research has uncovered many small, surprising ways you can weave even more disease prevention into individuals’ everyday life.
What you must do to prevent cancer
Filter your tap water: You will reduce your exposure to known or suspected carcinogens and hormone-disrupting chemicals.
Take plenty of water: Drinking plenty of water and other liquids may reduce the risk of bladder cancer by diluting the concentration of cancer-causing agents in urine and helping to flush them through the bladder faster. Drink at least 8 cups of liquid a day.
Cut down cell phone risks: Use your cell phone only for short calls or texts, or use a hands-free device that keeps the phone—and the radio frequency energy it emits—away from your head.
Check the use of folic acid: The B vitamin, essential for women who may become or are pregnant to prevent birth defects, is a double-edged sword when it comes to cancer risk. Consuming too much of the synthetic form (not foliate, found in leafy green veggies, orange juice, and other foods) has been linked to increased colon cancer risk, as well as higher lung cancer and prostate cancer risks.
Increase your calcium intake: Studies have shown that people who took calcium faithfully for 4 years had a 36 percent reduction in the development of new precancerous colon polyps.
Pay attention to pain: If you’re experiencing a bloated belly, pelvic pains, and an urgent need to urinate, see your doctor. These symptoms may signal ovarian cancer, particularly if they’re severe and frequent.
Avoid unnecessary scans: CT scans are a great diagnostic tool, but they deliver much more radiation than x-rays and may be overused. High doses of radiation can trigger leukaemia, so make sure scans are not repeated if you see multiple doctors, and ask if another test, such as an ultrasound or MRI, could substitute.
Stop tobacco use: Using any type of tobacco puts you on a collision course with cancer. Smoking has been linked to various types of cancer — including cancer of the lung, mouth, throat, larynx, pancreas, bladder, cervix and kidney, oral cavity and pancreas. Even if you don’t use tobacco, exposure to second-hand smoke might increase your risk of lung cancer.
Eat a healthy diet: Eat plenty of fruits and vegetables. Base your diet on fruits, vegetables and other foods from plant sources — such as whole grains and beans.
Avoid obesity. Eat lighter and leaner by choosing fewer high-calorie foods, including refined sugars and fat from animal sources.
Limit processed meats: A report from the International Agency for Research on Cancer, the cancer agency of the World Health Organization, concluded that eating large amounts of processed meat can slightly increase the risk of certain types of cancer.
Maintain a healthy weight and be physically active: Maintaining a healthy weight might lower the risk of various types of cancer, including cancer of the breast, prostate, lung, colon and kidney.
Physical activity counts: In addition to helping you control your weight, physical activity on its own might lower the risk of breast cancer and colon cancer. Moderate exercise such as brisk walking 2 hours a week cuts risk of breast cancer by 18 percent. Regular workouts may lower your risks by helping you burn fat, which otherwise produces its own estrogen, a known contributor to breast cancer.
Protect yourself from the sun: Skin cancer is one of the most common kinds of cancer and one of the most preventable.
Get immunized: Cancer prevention includes protection from certain viral infections. Talk to your doctor about immunization against: Hepatitis B. Hepatitis B can increase the risk of developing liver cancer.
Avoid risky behaviours: Practice safe sex because another effective cancer prevention tactic is to avoid risky behaviours that can lead to infections that, in turn, might increase the risk of cancer.
Get regular medical checks: Regular self-exams and screenings for various types of cancers such as cancer of the skin, colon, cervix and breast and can increase your chances of discovering cancer early, when treatment is most likely to be successful.
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